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In recent years, the majority of clinicians have recognized the significance of ultrasound in the comprehensive evaluation of pediatric patients presenting with both abdominal and thoracic diseases. For many years, it was widely believed that lung ultrasound (LUS) was unfeasible due to the presence of air, which acts as an insurmountable barrier to ultrasound waves. However, the development of pathological processes in the pleura and lungs creates conditions that reduce pulmonary aeration in specific areas. This gives rise to the so-called "acoustic window," which enables investigators to obtain reliable diagnostic data and perform both diagnostic and therapeutic interventions in the affected region.
Currently, the rate of diagnostic and tactical errors in recognizing pleuropulmonary complications of destructive pneumonia in clinical practice remains substantially high. The problem of community-acquired pneumonia (CAP) in children retains its critical relevance today, primarily due to the persistently high incidence rates. Pulmonary complications of community-acquired pneumonia include pleural empyema, abscesses, necrotizing or destructive pneumonia, bronchopleural fistula formation, and acute respiratory distress syndrome (ARDS). According to various authors, the incidence of purulent-destructive complications in community-acquired pneumonia ranges from 7% to 15%. Mortality rates in such cases vary between 8.7% and 18.5%, representing one of the highest mortality figures among all purulent-septic diseases.
Aim of the Study. To improve the diagnostic and treatment outcomes of destructive pneumonia in children.
2. Materials and Methods
We observed 148 patients with various forms of acute destructive pneumonia admitted to the purulent-septic department of the Regional Children's Multidisciplinary Medical Center between 2015 and 2025. Among them, 117 children aged from 1 month to 18 years presented with pleuropulmonary complications (72 with pyothorax and 45 with pyopneumothorax). The age distribution of the patients was as follows: 58 (49%) children were aged from 1 month to 3 years, 29 (25%) were aged 3 to 7 years, 16 (14%) were aged 7 to 11 years, and 14 (12%) were aged 11 to 18 years.
Linear and convex probes ranging from 3.7 to 7.5 MHz were utilized for the evaluation of the lungs and pleural cavity, selected depending on the child's age as well as the size and depth of the pathological focus.
Patients were examined in both supine (lying) and erect (standing) positions. Standard anatomical and topographic lines of the chest wall served as reference points for probe placement. The anterior and lateral surfaces of the chest wall were examined first, followed by a step-by-step intercostal space evaluation, moving the transducer from top to bottom. The basal segments of the lungs and the costodiaphragmatic recesses (sinuses) were scanned through the acoustic windows of the liver and spleen. Based on these examinations, the specific characteristics of echographic changes in the lungs and pleura were determined for various forms of destructive pneumonia.
Pleural complications were detected radiographically in 90% of cases. In contrast, ultrasound (US) detected the presence of pleural fluid in 100% of instances; moreover, 109 patients had an effusion volume exceeding 100 mL, while 8 patients presented with a minor amount (25–50 mL) that was not visualized radiographically. Echographic findings were correlated with clinical and radiographic results in all 117 patients; computed tomography (CT) scans were additionally performed in 10 patients for further clarification and differential diagnosis.
During ultrasound scanning of a free pleural cavity, the effusion typically formed an echonegative zone and was clearly traced as anechoic areas, resembling an amoeboid pattern. Separation of the parietal and visceral pleural layers was clearly visualized, with the width of the separation determined by the volume of the pleural effusion. Pleural effusion accompanied by fibrinous deposits presented as multiple linear echostructures of varying thickness, caused by the precipitation of fibrin strands.
Thus, the results of this study demonstrated that the accuracy of ultrasound diagnostics in cases of pyothorax and pyopneumothorax is 100%. A vital practical aspect of utilizing ultrasound in pleural cavity examinations is its ability to determine the optimal site for thoracocentesis (puncture). Destructive foci are diagnosed via ultrasound earlier than by conventional radiography. All these findings provide a solid foundation for recommending the widespread implementation of ultrasound as a screening method and a primary tool for detecting pathological changes in the pleural cavity.
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